Housing Design for an Increasingly Older Population: Redefining Assisted Living for the Mentally and Physically Frail

VICTOR REGNIER, FAIA, is Professor of Architecture and Gerontology and ACSA Distinguished Professor in the School of Architecture at the University of Southern California. As a teacher, researcher, and architect, he has focused his academic and professional life on the design of housing and community settings for older people. He holds a joint professorship between the USC School of Architecture and the Leonard Davis School of Gerontology, and is the only person to have achieved fellowship status in both the American Institute of Architects and the Gerontological Society of America.

Acknowledgments xix Foreword xxiii About the Companion Website xxxiii 1 What Do Older People Want? 1 What Possibilities Would Frail Older People Prefer in a Housing Solution? 1 How We Age Is Often Unpredictable 1 Strategy One: Stay in the House and See What Happens 2 Strategy Two: Plan the Move and Explore Other Scenarios 5 What Aspects of Housing and Services Best Serve the Older Frail? 9 Endnotes 10 2 What Are the Major Aging Changes that Affect Independence? 13 Changes in Sensory Modalities 13 Chronic Conditions and Disability that Limit Independence 17 Will Chronic Disease Continue to Decrease? 18 Endnotes 22 3 Demographics and Living Arrangements 25 Mortality and Fertility on the World Stage 25 Longevity Is a Primary Driver of Aging Population Growth 26 World Population Growth: 65+, 85+, 100+ 26 China Is the Most Rapidly Aging Country in the World 27 European Aging Experience: Been There, Done That 28 The Triple Whammy of the Aging of Japan: Longevity, Low Fertility, and Low In-migration 29 What About the Growth Rate of the 65+ and 85+ Population in the US? 29 The Centenarians and Near Centenarians: 100- and 90-Year-Olds in the US 31 Impacts of Demographic Growth 31 What Other Demographic Issues Will Affect the Future? 33 Endnotes 34 4 How Is Long-Term Care Defined? What Are the Choices? 37 What Are the Major LTC Alternatives? 37 Nursing Home Facts and Figures 38 What Are the Problems of Traditional Nursing Homes? 38 Will Green House (c) and Small House Models Replace Traditional Nursing Homes? 41 What Attributes Should We Strive to Include in New Nursing Homes? 42 How Do Assisted Living (AL) and Residential Care Settings Differ? 43 Assisted Living, Problem One: Care for More Dependent Residents 44 Assisted Living, Problem Two: Cost of Care and Lack of Reimbursement 44 How Do Assisted Living Residents Differ from Nursing Home Residents? 45 What Can We Learn from Hospice Models? 45 Home Care Through Family Members and Formal Sources 47 Reformulating Home Care to Work at the Margin of Need 48 Endnotes 50 5 Concepts and Objectives for Housing the Frail 53 First-Order Concepts 53 Second-Order Concepts 53 Environmental Docility Hypothesis 54 Endnotes 55 6 20 Design Ideas and Concepts that Can Make a Difference 57 The Neighborhood, Site Issues, and Outdoor Space 57 ONE: Defining a Good Accessible Site 57 TWO: Orientation to the Outdoors and the Natural World 58 THREE: Courtyards for Density, Views, and Social Exchange 60 FOUR: Interstitial Spaces on the Building's Edge 60 FIVE: Atriums for Social Interaction and Exercise 62 Refining Design Attributes and Considerations 64 SIX: Making the Building Approachable, Friendly, and Noninstitutional 64 SEVEN: Create a Building that Is Accommodating and Adaptable 65 EIGHT: The Building Design Should Encourage Walking 66 NINE: Invite Natural Light 68 TEN: Embrace the Open Plan 69 ELEVEN: The Impact of Interior Design on the Senses 70 TWELVE: Special Considerations for Designing for Dementia 72 Stimulating Social Interaction 74 THIRTEEN: Places that Welcome Family and Friends 74 FOURTEEN: The 100% Corner or Community Table 76 FIFTEEN: Places for Unobtrusive Observation and Previewing 78 SIXTEEN: The Retreat 80 SEVENTEEN: The Primary Path 81 EIGHTEEN: Triangulation 82 Planning the Dwelling Unit 83 NINETEEN: Personalization that Makes the Unit Your Own 83 TWENTY: Dwelling Unit Design 85 Endnotes 88 7 12 Caregiving and Management Practices that Avoid an Institutional Lifestyle 91 Effective Caregiving Strategies 91 ONE: Accommodating Independence Through a Home Care Model 91 TWO: Primary, Secondary, and Designated Caregivers and the Computer 93 THREE: Activity of Daily Living (ADL) Therapy 94